University Hospitals of Cleveland serves as a consultant station to one "remote" hospital. A second remote hospital is being added to the system this year and a third one will be added in the next year. The Telemedicine system uses Laser Mediated two-way wide band audio-video communication channels. These are supplemented by telephone lines to carry certain audio and command information. In the second year of this project, plans have been developed to build a variable frame rate television system that uses commercial telephone lines to transmit audio and black and white pictures. At the end of Year 2, consultants from a central monitoring station at University Hospitals will serve via a two-way channel an operating room in the VA Hospital, via two two-way links to Forest City Hospital, an operating room, an intensive care unit, the newborn nursery, or the delivery suite of that hospital using one fixed camera in the operating room and one mobile camera for the other locations, and via a two-way link, the Cuyahoga County Hospital using the communications system subserved by telephone lines. The project is supported by a team of Operations Research engineers who are evaluating the clinical services in the different areas that are going to be affected by telemedicine and who are preparing the instruments to measure the changes that are being produced by telemedicine in terms of service patterns, quality of care, accessibility, acceptability, reliability, and also to measure the cost benefit ratio of the system. The clinical team is already operating the system daily to the VA Hospital and has made extensive preparations to activate the first link into the intensive care unit and newborn nursery as well as the operating room of the second hospital, which is a small, inner-city, community hospital in need of specialized consultants.